Dual strategy fixes valve and artery heart disease

A "hybrid" approach combining angioplasty followed by valve surgery works well for people who have both coronary artery disease and valve problems, according to a new report.

Patients with such complex heart disease often undergo simultaneous coronary bypass surgery (also known as CABG) and valve surgery, but the long operating time can make this risky.

Dr. John G. Byrne from Vanderbilt University Medical Center, Nashville, and his colleagues thought it might be safer to first perform angioplasty to open clogged coronary arteries - which can be done outside the OR - and then follow that with valve surgery. They investigated this approach in a study of 26 high-risk patients with coronary artery and valve disease.

One of the patients died four weeks after the procedure, for an operative mortality rate of 3.8 percent. This compares with an estimated mortality rate with conventional valve-and-bypass surgery of 22 percent that would be expected in this group of patients, the team reports in the Journal of the American College of Cardiology.

Survival rates were 78 percent after 1 year, 56 percent at 3 years, and 44 percent at 5 years, the report indicates.

"Our data demonstrate that, for selected patients with mixed coronary and valvular heart disease, a team approach whereby coronary lesions are treated in the catheterization laboratory and then valvular disease is treated in the operating room provides early outcomes far superior to those predicted for valve/CABG surgery," the investigators conclude.

"With an aging population, and with more patients coming to surgery with more risk factors, we will need to minimize surgical time and combine the best technologies available to achieve the best possible outcome," Byrne told Reuters Health

Byrne added that he plans to conduct more extensive clinical trials of the hybrid approach at Vanderbilt.

SOURCE: Journal of the American College of Cardiology, January 4, 2005.